Archive for October, 2007

Nobody will argue that the death of 12 year old Omar Rivera was not a tragedy, but why does his name need to be dishonored by suing the hospital and NYC Health and Hospital Corp? This is not a one-sided argument, however. This is the type of high-profile case that vilifies everyone, from the parents, to the hospital that treated the child, to the media, to our entire healthcare and judicial systems. Firstly, this case is already causing a panic in the population because of how it has been handled by the media. This MRSA, or methicillin-resistant Staph Aureus, was first isolated in 1953 and has been a constant battle in hospitals, showing up in the sickest, most stressed and immunocompromised patients. Along with VRE (vancomycin-resistant enterococcus), healthcare workers have constantly put themselves at risk to treat these “superbugs” that are nothing more than the natural response of bacteria to our use (and often overuse) of antibiotics. All organisms have the ability to adapt to environmental pressures, and since the advent of antibiotics, humanity has pressured bacteria to evolve in order to survive our chemical assault. The unfortunate part is, that through irresponsible use of antibiotics, we have hastened this evolution and continue to encourage microbial resistance. As an ER doctor, since moving from Massachusetts to California just 4 years ago, we have gone from treating skin infections, known as “cellulitis”, usually caused by Staph and/or Strep bacteria (which live on all of our skin and you can’t get rid of, no matter how much antibacterial soap you use), with penicillin or a 1st generation cephalosporin like cephalexin (Keflex), to using entirely different classes or multiple antibiotics due to resistance. Currently in California, greater than 50% of skin infections are due to MRSA, which is now classified as “community acquired”, since we no longer see it exclusively in very ill or immunocompromised patients. Because this is such a new phenomenon, I still see primary care doctors and others placing patients on the “old” antibiotics for these newer “superbugs”. It sounds like young Mr. Rivera was placed on amoxicillin for his cellulitis, which just a few years ago, would have been fine. This issue is so new, however, that studies are just coming out that document these new changes in resistance patterns and the proper antibiotic treatment is still under development.

So what can we do? We as citizens need to question any and all antibiotic use. Stop demanding antibiotics from your doctors. Stop using antimicrobial soaps and sanitizers (see this previous rant)- we evolved to live commensualistically with bacteria on our skin, you cannot and should not sterilize yourself. In today’s high-volume, low-reimbursement healthcare system, it is easier for a doctor to prescribe antibiotics for a viral cold than to explain to a demanding, rude, uninformed patient, that antibiotics are only for bacterial infections like pneumonia, cellulitis, and urinary tract infections and do not treat viruses. People expect a “magic bullet”, that by going to the doctor there will be come miracle cure for every ailment and sniffle. Unfortunately this is not the case, but these expectations, along with the corporatization of healthcare, demanding “customer satisfaction” over good medical practice, is indirectly leading to the type of irresponsible antibiotic use that is causing these “superbugs” in the first place. We as physicians need to take the time to discuss the proper use of antibiotics with our patients and give them only what they need, not what they think they need.

I could continue to rant about how our current legal system and our “sue-happy” nation is one of the major factors contributing to the impending downfall of our healthcare system, and how the Rivera family is disgracing the memory of their child by trying to leverage $25 million dollars from their son’s death, but I will leave it at this: Everything we do has an impact, from every bit of fuel we burn contributing to global warming, to each mass produced bit of clothing we buy contributing to the oppression of those workers and dispersing toxins into the environment, to every dose of antibiotic we take contributing to antimicrobial resistance. Most of our problems on a macroscopic scale are being caused by our individual actions on a microscopic scale. If we each educate ourselves and begin making the right decisions, we will see a slowing of these phenomena, which represent nothing more than the equal and opposite reaction of our personal and collective actions.

Shawn Frayne, a 28 year old Californian inventor, has discovered a way to generate efficient power from the wind-generated vibrations. It seems that he was inspired by the collapse of the famous Tacoma Narrows bridge, or “galloping Gertie”, in 1940. Wind flowing over a stretched mylar band produces similar vibrations, and by attaching a small magnet on either end that interact with copper coils, power is generated that is supposedly 10-30 times more efficient than the best microturbines! Here is the Popular Mechanics page with a video.

This represents a truly innovative solution to sustainable power generation. If we can encourage research and development and then encourage adoption and use of these types of efficient, small-scale power sources, our coal-fired and nuclear power plants will be things of the past.

How about a clean energy X-Prize? Any uber-rich supporter? Sir Branson?

Dear Naysayers (Fox news, climate change non-believers, etc.):
Please, please, please, now that Al Gore has won the Nobel Peace Prize, rather than lambasting and insulting him because you don’t agree with his stance on climate change, ask yourself, “Why would Gore win a Nobel prize for his efforts?” Do you really think that the Nobel organization would grant a prize for an effort that was all propaganda and opinion? Do you think that more than 2000 of the world’s best climate and environmental experts on the UN’s Panel for Climate Change are clueless? If you still don’t believe in climate change, I implore you to turn off Fox news for a little while, stop listening to your tight group of conservative friends, and venture out, question those sources and hold them responsible. Most of the dissenters to climate change choose to cast insults, nitpick on small irregularities in findings, or quote data that misrepresents the issues due to scale. The classic argument along these lines is that this is a “natural cycle”, however if you look back a few hundred thousand years it becomes obvious that this is far from “natural.”
Basically, I’m asking you to skip the spins and the unveiled propaganda from the conservatives and get right to the point – do you really think that the rest of the world, including all of Europe, the UN, The Nobel Prize Committee, and an amazing number of other organizations, are making this up? Start thinking for yourselves and get on board with the rest of humanity regardless of your political or religious affiliation.

Recreational ATVs are horrid. I am an ER physician near Pismo Beach, CA, where thousands of campers and ATV riders flock every weekend, spewing fumes, tearing up the beach and dunes, and getting injured regularly, sometimes severely or fatally. We have people killed every year, a 4 year old was run over just last month, a 21 year old girl is now a permanent quadriplegic, plus hundreds of broken bones and lacerations per season. Many ATVers also put their small children on these motorized deathtraps and have them ride around in the midst of thousands of other high-speed motorists, some of whom are under the influence of alcohol and/or drugs.
What ever happened to human-powered recreation? It’s much more rewarding when you hike or ride your bike to the top of a mountain, rather than being artificially propelled while wasting fossil fuel, polluting, and ripping up the landscape. Along similar lines, sometimes when we go surfing along the coast,jetskiiers will obliviously and obnoxiously choke us with their exhaust in their quest for speed and bigger air over the waves. The dolphins that often play in those waves are nowhere to be seen on these days, driven off by the noise, fumes, and oil slicks floating on the water. Human-powered recreation is healthier, less dangerous, and has much less environmental impact than the motorized equivalent. To make matters worse, the average person that uses these vehicles has little to no regard for the environment in the first place, driving jacked-up trucks and towing huge “toy-haulers” for hundreds of miles so that they can “camp” in RVs and use tons ofpre-packaged food and disposable utensils (leaving a great deal behind on the beach). The same people that will argue that it has minimal impact and is safe, are the same people that think it is a good idea to drive a Hummer around town, or go to the grocery store in an Escalade.
And yes, I know that hikers, climbers, and mountain bikers effect the local environment as well, but as with everything else, there is a continuum of effect with responsible hikers and bikers being relatively low on the scale, and ATV and motorcycle riders causing much more impact.
If I was looking for a way to waste fuel, destroy wildlife habitat, get minimal actual exercise while exposing myself and my family to as dangerous a situation as possible, all under the pretense of “being outdoors”, it sounds like the perfect family vacation.

I was able to attend most of an electric vehicle seminar at Cal Poly today sponsored by the Central Coast Clean Cities Coalition and presented by Bob of Electroauto. Now I’ve lusted after the electric car conversion kits from Electroauto for years, so it was interesting to see the husband and wife founding team presenting information on electric vehicle practicality and efficiency, cost of conversion and maintenance, conversion techniques, chassis selection, battery issues, and basically answered any question someone would have if you’re considering building an electric car.The electroauto kits range from $6000 for a “universal” DC kit (+ ~$2000 for batteries every 4 years or so) that requires some fabrication and fitting by the installer, to $13,415 (+batteries and shipping) for a custom AC “Voltsporsche” kit that bolts directly into a Porsche 914 chassis. The Voltsporsche kit is the highest performace, with a top speed of 100mph and a range from 100-150 miles although most kits promise highway speeds up to 70mph with a range of 50-100 miles. The speed and range of these kits is multifactorial and depends primarily on the weight and aerodynamics of your chassis, choice of AC or DC kits, and your choice of batteries, but is also affected by driving techniques, and use of accessories like A/C, heat, and other electronics. AC kits, although more expensive, are slightly more efficient and allow regenerative braking (which reclaims up to 1/3 of the energy used to accelerate to that speed) and a broad array of battery choices in comparison to DC kits. These kits can be installed by a technician for around $5000, or a tinkerer with moderate skill can install the kit in a weekend or two, depending on the shape of your chassis and the kit you choose.
Conclusions? If you drive 50 miles or less (85%+ of commuters) and are in the market for a vehicle, one of these are the way to go. For $20-$30k, you can have a fully functional highway-capable electric vehicle with 1/3 of the operating cost of a regular car, and significantly less or even no emissions, depending on your power source. One of the common myths you’ll hear from detractors (like auto manufacturers and naysayers that don’t check their sources) is the argument that you make just as much pollution from the power source from your charging as you do from a combustion engine. The so-called “long tailpipe” phenomenon, is decidedly false – even with power from the dirtiest coal-fired power plant, emissions from charging an electric car are 2/3 less than that of a combustion engine. Calculations demonstrating this are detailed on the Tesla Roadster website (pdf file link). Although vehicles like the Zap-X and Tesla roadster are slotted to be available over the next few years, they cost $60K and $100K respectively, and are thus far vaporware. We will be waiting a few years before consumer electrics come down to the price of an installed Electroauto kit, and although they will probably have somewhat longer ranges, they will be more complicated, not be user maintainable, and you won’t have the fun and pride of selecting, building and maintaining your own custom vehicle! With battery technology improving rapidly, you can start with cheap and reliable flooded lead batteries, and as you recycle and replace your batteries every 3-5 years, more efficient and lighter options will become more and more reasonably priced.
Essentially, if you are prepared to spend the money on a new or newer used car and you are prepared for a little legwork or some tinkering, this is the most cost-effective and environmentally friendly way to have a mid-range commuter car. If you slap some solar panels on your home as well, you’ll be the envy of every treehugger on the block!

Climate Change and Peak Oil

In the United States, we use over 20 million barrels of oil per day, over 7 billion barrels per year, importing more than half of this volume from Africa, the Middle East, Russia, and other oil-producing states.
In purchasing this oil from other parts of the world we put billions of dollars per year into the hands of oil shieks, outdated theocratic rulerships, radical Islamic militants, and even terrorists. The pursuit of this oil has many costs, including the billions of American tax dollars spent on a war that is largely political in order to secure our access to this resource. Already unstable, any breakdown in the current oil economy will lead to skyrocketing fuel prices for Americans. Even the experts within the oil industry predict "peak oil", that is, the highest possible global oil production, to come anywhere within the next 10-50 years. After that point the maximum amount of oil that we can pump out of the ground will decline despite the growing demand for oil for energy, plastics, gasoline, jet fuel, and the many other uses for petroleum. This is a second major reason for a fuel cost spike, that will hit our economy terribly, from which we may not ever recover.
A second major global crisis that is intimately intertwined with energy is climate change. The latest data suggests that the polar ice caps are melting even faster than previously predicted, leading to erratic weather patterns, severe droughts and floods, and rising sea levels. If our current energy consumption continues to grow as predicted, we will have set the stage for severe natural disasters displacing millions of people from their homes, killing an unestimateable number of humans and animal species, costing billions of relief dollars, as well as costing more than 5% per year of global economic growth indefinitely. These two issues go hand in hand – our voracious appetite for energy requires the burning of more and more fossil fuels which in turn leads to more of the CO2 emissions that cause global warming. This is not supposition and is not theory. It is fact. There are many resources to support these estimates and projections from leading politicians, economists, climate experts, geologists, and other experts in their fields.
What this means is that this energy crisis will occur within many of our lifetimes and all of our children's lifetimes. We cannot leave the downfall of our civilization and the scarring of our globe as a legacy to our next generation. Do not take the media’s word, or my word for that matter, research it for yourself so you understand the dire position of our current crises.